Journal of Urgent Care Medicine

Brugada Syndrome in the Urgent Care Center: A Case Report

Urgent Message: Brugada syndrome may present with subtle electrocardiogram findings, and clinicians must recognize the pattern promptly to help prevent sudden cardiac death. Katherine Quinn, MS IV; Eric Mast, DO; M. Drew Mattin, MS IV; Todd Fredricks, DO, MSS Keywords: sudden cardiac death; Brugada syndrome; Brugada pattern; ventricular fibrillation Abstract Introduction: Syncope in young, otherwise healthy individuals is often attributed to benign causes but can occasionally signal life-threatening cardiac conditions. Brugada syndrome (BrS), a rare …

Pediatric Plantar Puncture Wound Through Rubber-Soled Footwear: A Case Report Highlighting Antibiotic Stewardship in Urgent Care

Urgent Message: Low-risk plantar puncture wounds in healthy children can be safely managed without antibiotics. Parents should receive instructions for return precautions. Adam Brandon Bondoc, MD Keywords: plantar puncture wound; pediatric puncture wound; rubber-soled footwear; pseudomonas aeruginosa; antibiotic stewardship; foreign body risk Abstract Introduction: Puncture wounds that occur through rubber-soled footwear increase the risk of infection from Pseudomonas aeruginosa. Prophylactic oral fluoroquinolones are frequently provided to adults for high-risk injuries. However, pediatric care is complicated …

An Evaluation of Unnecessary Prophylactic Antibiotics For Clean Lacerations

Urgent Message: Prophylactic antibiotic prescribing for patients with clean lacerations is a common but unnecessary practice. Rates of prescribing did not differ based on type of provider or physician specialty in this study of 20 urgent care centers. Michael Smart, PhD; Jennifer Bush, MSN, APRN, FNP-C/ENP-C Keywords: antimicrobial stewardship; prophylactic antibiotics; laceration repair; urgent care Abstract Background: Oral prophylactic antibiotics for clean lacerations that require suture repair are commonly prescribed when they are unneeded. We …

An Uncommon Cause of Rectal Pain: A Case Report of Fishbone Foreign Body

Urgent Message: Careful history and examination are required when assessing patients presenting with rectal pain. Clinicians should maintain a high index of suspicion for accidental foreign-body ingestion when assessing unexplained rectal discomfort. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Key Words: rectal pain; foreign body; proctoscopy; fishbone ingestion; hemorrhoids; gastrointestinal issues Abstract Clinical Presentation: A 50-year-old male with a history of type 2 diabetes mellitus and hemorrhoids presented to urgent …

Wheezing as a Pneumothorax Presentation: A Case Report

Urgent Message: For patients with presumed asthma exacerbation, clinicians must maintain a high index of suspicion for other etiologies, including pneumothorax. This may help avoid delays in potentially life-saving interventions when symptoms persist despite treatment or when physical exam findings are atypical. Badi Eghterafi, DO; Nazanin Hazhir Karzar, MD Keywords: asthma, wheezing, chest pain, pneumothorax, spontaneous pneumothorax Abstract Introduction: Large spontaneous pneumothorax is an uncommon but critical complication in patients with asthma. Clinicians evaluating presumed …

When Bell Palsy Is Actually a Stroke: A Case Report

Urgent Message: While Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis, it is important for urgent care clinicians to be able to quickly differentiate it from other more serious diagnoses. Keywords: facial palsy; stroke mimic; Bell palsy; central facial weakness; peripheral facial palsy; urgent care evaluation Luke Wisniewski, OMS3; Finley Kocher, OMS3; Muhammad Akhtar, MD Abstract Introduction: Bell palsy is the most common diagnosis for patients with unilateral facial weakness/paralysis …

Management of Acute Opioid Withdrawal in a Patient With an Unknown Prescribing History: A Case Report

Urgent Message: Opioid prescribing in urgent care can present difficulties, particularly in patients with an unclear prescription history where added caution is needed. There are a number of ways to reduce the risks associated with opioid prescribing and to initiate the treatment of opioid withdrawal in the urgent care setting. Jacob Mather, BSc MBChB Key Words: Addiction, Opioid Withdrawal, Prescribing, Urgent Care Abstract Introduction: We report a complex case of a 37-year-old woman presenting to …

Leveraging Physician-Patient Relationships to Increase Patient Portal Access During an Urgent Care Visit

Urgent Message: Urgent care physicians can leverage the physician-patient relationship established during a visit to improve patient portal enrollment and use in a healthcare system. Sandy Wang, MD, MPH; Carolyn Stern, MD; Kevin Fiscella, MD, MPH; Amaya Sanders, BS; Erik Herbert, BS; Rosie Booker, BS; Tyra Barton, LPN; Mechelle Sanders, PhD Key Words: Electronic Health Records, Patient Portals, Urgent Care, Quality Improvement Abstract Background: Patient portals for accessing electronic health records are useful for easy …

Chronic Calf Pain and Limp: A Case Report of Pediatric Slipped Capital Femoral Epiphysis

Urgent Message: Pediatric patients frequently present to urgent care with musculoskeletal complaints, but clinicians must remain aware of the less common surgical and medical emergencies that can present with these symptoms. Key Words: Slipped Capital Femoral Epiphysis; Pediatric Limp; Antalgic Gait; Obesity; Urgent Care Diagnosis Abstract Clinical Presentation: A 13-year-old male presented to a pediatric urgent care with the chief complaint of left calf pain for a month that had acutely worsened over the past …

Shortness of Breath in Pregnancy: Differentiating Physiology from Pathology in Urgent Care

Urgent Message: As shortness of breath and edema are common in pregnancy, urgent care clinicians must distinguish patients with normal physiologic changes from those with emergent conditions like venous thromboembolism, hypertension, eclampsia, and cardiomyopathy. John Ramos, MMS, PA-C, CAQ-EM Key Words: Ambulatory Care; Differential Diagnosis; Dyspnea; Pregnancy Complications; Pregnancy Complications, Cardiovascular Abstract Background: Physiologic changes in pregnancy contribute to shortness of breath and edema. However, these symptoms can also be caused by serious etiologies including …

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